Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
Ann Phys Rehabil Med. 2018 Sep;61(5):286-291. doi: 10.1016/j.rehab.2018.04.005. Epub 2018 May 12.
Anodal stimulation increases cortical excitably, whereas cathodal stimulation decreases cortical excitability. Dual transcranial direct current stimulation (tDCS; anodal over the lesioned hemisphere, cathodal over the non-lesioned hemisphere) was found to enhance motor learning. The corresponding tDCS-induced changes were reported to reduce the inhibition exerted by the unaffected hemisphere on the affected hemisphere and restore the normal balance of the interhemispheric inhibition. Most studies were devoted to the possible modification of upper-limb motor function after tDCS; however, almost no study has demonstrated its effects on lower-limb function and gait, which are also commonly disordered in stroke patients with motor deficits. In this randomized sham-controlled crossover study, we included 19 patients with sub-acute stroke. Participants were randomly allocated to receive real or sham dual-tDCS followed by conventional physical therapy with an intervention interval of at least 1 week. Dual-tDCS was applied over the lower-limb M1 at 2-mA intensity for 20min. Lower-limb performance was assessed by the Timed Up and Go (TUG) and Five-Times-Sit-To-Stand (FTSTS) tests and muscle strength was assessed by peak knee torque of extension. We found a significant increase in time to perform the FTSST for the real group, with improvements significantly greater than for the sham group; the TUG score was significantly increased but not higher than for the sham group. An after-effect on FTSTS was found at approximately 1 week after the real intervention. Muscle strength was unchanged in both limbs for both real and sham groups. Our results suggest that a single session of dual-tDCS before conventional physical therapy could improve sit-to-stand performance, which appeared to be improved over conventional physical therapy alone. However, strength performance was not increased after the combination treatment.
阳极刺激增加皮质兴奋性，而阴极刺激降低皮质兴奋性。双经颅直流电刺激（tDCS；病变半球给予阳极刺激，非病变半球给予阴极刺激）被发现可增强运动学习。据报道，相应的 tDCS 诱导的变化可减少未受影响半球对受影响半球的抑制作用，并恢复半球间抑制的正常平衡。大多数研究都致力于 tDCS 后上肢运动功能的可能改变；然而，几乎没有研究表明其对下肢功能和步态的影响，而下肢功能和步态在运动功能障碍的脑卒中患者中也经常受到干扰。在这项随机假对照交叉研究中，我们纳入了 19 名亚急性脑卒中患者。参与者被随机分配接受真实或假双 tDCS 治疗，随后进行常规物理治疗，干预间隔至少 1 周。双 tDCS 在下肢 M1 以 2 mA 强度进行 20 分钟。下肢功能通过计时起立行走（TUG）和 5 次坐立站起（FTSTS）测试评估，肌肉力量通过伸膝峰值扭矩评估。我们发现真实组在执行 FTSST 的时间上有显著增加，与假组相比，改善显著更大；TUG 评分显著增加，但不比假组高。在真实干预后约 1 周，发现 FTSTS 有后效。真实和假组的四肢肌肉力量均无变化。我们的结果表明，常规物理治疗前单次双 tDCS 治疗可改善坐立站起的表现，且似乎优于单独常规物理治疗。然而，联合治疗后力量表现并未增加。
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